PRINCIPI ZBRINJAVANJA DISAJNOG PUTA U HITNIM STANJIMA
Ključne reči:
otežan disajni put, LEMON, Malampati, DAS algoritam
Sažetak
Obezbeđivanje disajnog puta ima krucijalan značaj u tretmanu hitnih stanja. Brojne komplikacije, koje dodatno mogu pogoršati stanje bolesnika, mogu nastati kao posledica poteškoća prilikom obezbeđivanja disajnog puta. Učestalost ovih komplikacija je značajno veća u hitnim stanjima u poređenju sa elektivnom hirurgijom. Zbog toga, neophodna je brza procena i adekvatno zbrinjavanje disajnog puta. Najpoznatiji i najčešće korišćeni testovi za procenu disajnog puta u hitnim stanjima su Malampatijeve klase i serija skraćenih postupaka, koji se mnemotehnički, nazivaju LEMON. Oni imaju imaju značajnu ulogu u predviđanju otežanog obezbeđivanja disajnog puta i omogućavaju adekvatnu pripremu medicinskog tima. U slučaju procene da će disajni put biti otežan, najbolje je slediti algoritme udruženja za otežan disajni put,koji pored toga što olakšavaju lekarima zbrinjavanje problematičnog disajnog puta, ujedno štite lekare od krivične odgovornosti, ako dođe do komplikacija ili smrtnog ishoda. Na ovaj način zbrinjavanje disajnog puta u hitnim stanjima može predstavljati ozbiljan, ali ne i nepremostiv problem.
Reference
1.Cook TM, MacDougall-Davis SR. Complications and failure of airway management. British Journal of Anaesthesia. 2012;109 (1):68-85. doi: 10.1093/bja/aes393.
2.Dimić N, Melentijević SS, Stevanović K, Nastasović T, Kalezić N. Komplikacije u intraoperativnom i neposrednom postoperativnom periodu – predikcija, prevencija i lečenje. U “Perioperativna medicina 1” urednika Kalezić N. 2020; 19:375-401.
3. Crewdson K, Rehn M, Lockey D. Airway management in pre-hospital critical care: a review of the evidence for a 'top five' research priority. Scand J Trauma Resusc Emerg Med. 2018;26(1):89. doi: 10.1186/s13049-018-0556-4.
4. Schnittker R, Marshall S, Berecki‐Gisolf J. Patient and surgery factors associated with the incidence of failed and difficult intubation. Anaesthesia. 2020; 75:756-766. doi: 10.1111/anae.14997.
5. Kalezić N, Lakićević M, Sabljak V, Mojsić B, Antonijević V, Stevanović K. Evaluacija i procena disajnog puta, u: Inicijalni tretman urgentnih stanja u medicini,drugo, izmenjeno i dopunjeno izdanje, urednika: Kalezić N. Medicinski fakultet, Beograd, 2016; 1(2):31-48.
6. Cook TM. Strategies for the prevention of airway complications – a narrative review. Anaesthesia. 2018; 73: 93-111. doi: 10.1111/anae.14123.
7. Baker P. Assessment before airway management. Anesthesiol Clin. 2015;33(2):257-78. doi: 10.1016/j.anclin.2015.02.001.
8. Green SM, Roback MG. Is the Mallampati Score Useful for Emergency Department Airway Management or Procedural Sedation? Ann Emerg Med. 2019;74(2):251-259. doi: 10.1016/j.annemergmed.2018.12.021.
9. Ezri T,Warters RD, Szmuk Pet al.The incidence of class “zero” airway and the impact of Mallampati score, age, sex, and body mass index on prediction of laryngoscopy grade.Anesth Analg. 2001; 93:1073-1075. doi: 10.1097/00000539-200110000-00055.
10. Healy DW, LaHart EJ,Peoples EEet al.A comparison of the Mallampati evaluation in neutral or extended cervical spine positions: a retrospective observational study of >80 000 patients.Br J Anaesth. 2016; 116:690-698. doi: 10.1093/bja/aew056.
11. Ilper H, Franz-Jäger C, Byhahn C, Klages M, Ackermann HH, Zacharowski K, et al. Update Mallampati : Theoretische und praktische Kenntnisse europäischer Anästhesisten zur Basisevaluation der Atemwege [Update Mallampati : Theoretical and practical knowledge of European anesthetists on basic evaluation of airways]. Anaesthesist. 2018;67(10):738-744. doi: 10.1007/s00101-018-0481-y.
12. Ji SM, Moon EJ, Kim TJ, Yi JW, Seo H, Lee BJ. Correlation between modified LEMON score and intubation difficulty in adult trauma patients undergoing emergency surgery. World J Emerg Surg. 2018;13:33. doi: 10.1186/s13017-018-0195-0.
13. Braude D. Difficult airways are "LEMONS": updating the LEMON mneumonic to account for time and oxygen reserve. Ann Emerg Med. 2006;47(6):581. doi: 10.1016/j.annemergmed.2006.02.030.
14. Hagiwara Y, Watase H, Okamoto H, Goto T, Hasegawa K; Japanese Emergency Medicine Network Investigators. Prospective validation of the modified LEMON criteria to predict difficult intubation in the ED. Am J Emerg Med. 2015;33(10):1492-6. doi: 10.1016/j.ajem.2015.06.038.
15. Grensemann J, Simon M, Kluge S. Airway management in intensive care and emergency medicine : What is new? (In German). Med Klin Intensivmed Notfmed. 2019;114(4):334-341. doi: 10.1007/s00063-018-0498-7.
16. Mosier J, Reardon RF, DeVries PA, Stang JL, Nelsen A, Prekker ME, Driver BE. Time to Loss of Preoxygenation in Emergency Department Patients. J Emerg Med. 2020; S0736-4679(20):30667-3. doi: 10.1016/j.jemermed.2020.06.064.
17. Kalezić N, Mandraš A, Vasiljević S, Lakićević M, Sabljak V, Stevanović K. Oprema za obezbeđivanje disajnog puta i veštačkog disanja. u: Inicijalni tretman urgentnih stanja u medicini,drugo, izmenjeno i dopunjeno izdanje, urednika: Kalezić N. Medicinski fakultet, Beograd, 2016; 1(3):49-68.
18. Kalezić N, Ivošević T, Stevanović K, Cvetković A, Mitić R, Lakićević M, Pavlović A. Screening of difficult airway management - what do we often forget? 10th Sarajevo Anesthesia Forum, Book of Proceedings, Sarajevo, 2018; p-39-47.
19. Binks MJ, Holyoak RS, Melhuish TM, Vlok R, Bond E, White LD. Apneic oxygenation during intubation in the emergency department and during retrieval: A systematic review and meta-analysis. Am J Emerg Med. 2017;35(10):1542-1546. doi: 10.1016/j.ajem.2017.06.046.
20. Kalezić N, Dimić N, Karadžić Kočica M, Lakićević M. Disajni put – prioritet prvog reda hitnosti. Praxis Medica. 2019; 48(1): 31-5.
21. Kalezić N, Stojanović M, Ivošević T, Nastasović T, Lakićević M, Stojanović M. Procena disajnog puta, u: Kalezić N. Perioperativna medicina 1. 2020; 3:47-64.
22. Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, et al. Difficult Airway Society intubation guidelines working group, Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. BJA. 2015; 115(6):827-48. doi: 10.1093/bja/aev371.
23. Kalezić N, Stevanović K, Zdravković I, Sabljak V, Tošković A, Krstić S, Srećković S. Rešavanje problematičnog disajnog puta, u: Inicijalni tretman urgentnih stanja u medicini,drugo, izmenjeno i dopunjeno izdanje, urednika: Kalezić N. Medicinski fakultet, Beograd, 2016; 1(7):115-36.
2.Dimić N, Melentijević SS, Stevanović K, Nastasović T, Kalezić N. Komplikacije u intraoperativnom i neposrednom postoperativnom periodu – predikcija, prevencija i lečenje. U “Perioperativna medicina 1” urednika Kalezić N. 2020; 19:375-401.
3. Crewdson K, Rehn M, Lockey D. Airway management in pre-hospital critical care: a review of the evidence for a 'top five' research priority. Scand J Trauma Resusc Emerg Med. 2018;26(1):89. doi: 10.1186/s13049-018-0556-4.
4. Schnittker R, Marshall S, Berecki‐Gisolf J. Patient and surgery factors associated with the incidence of failed and difficult intubation. Anaesthesia. 2020; 75:756-766. doi: 10.1111/anae.14997.
5. Kalezić N, Lakićević M, Sabljak V, Mojsić B, Antonijević V, Stevanović K. Evaluacija i procena disajnog puta, u: Inicijalni tretman urgentnih stanja u medicini,drugo, izmenjeno i dopunjeno izdanje, urednika: Kalezić N. Medicinski fakultet, Beograd, 2016; 1(2):31-48.
6. Cook TM. Strategies for the prevention of airway complications – a narrative review. Anaesthesia. 2018; 73: 93-111. doi: 10.1111/anae.14123.
7. Baker P. Assessment before airway management. Anesthesiol Clin. 2015;33(2):257-78. doi: 10.1016/j.anclin.2015.02.001.
8. Green SM, Roback MG. Is the Mallampati Score Useful for Emergency Department Airway Management or Procedural Sedation? Ann Emerg Med. 2019;74(2):251-259. doi: 10.1016/j.annemergmed.2018.12.021.
9. Ezri T,Warters RD, Szmuk Pet al.The incidence of class “zero” airway and the impact of Mallampati score, age, sex, and body mass index on prediction of laryngoscopy grade.Anesth Analg. 2001; 93:1073-1075. doi: 10.1097/00000539-200110000-00055.
10. Healy DW, LaHart EJ,Peoples EEet al.A comparison of the Mallampati evaluation in neutral or extended cervical spine positions: a retrospective observational study of >80 000 patients.Br J Anaesth. 2016; 116:690-698. doi: 10.1093/bja/aew056.
11. Ilper H, Franz-Jäger C, Byhahn C, Klages M, Ackermann HH, Zacharowski K, et al. Update Mallampati : Theoretische und praktische Kenntnisse europäischer Anästhesisten zur Basisevaluation der Atemwege [Update Mallampati : Theoretical and practical knowledge of European anesthetists on basic evaluation of airways]. Anaesthesist. 2018;67(10):738-744. doi: 10.1007/s00101-018-0481-y.
12. Ji SM, Moon EJ, Kim TJ, Yi JW, Seo H, Lee BJ. Correlation between modified LEMON score and intubation difficulty in adult trauma patients undergoing emergency surgery. World J Emerg Surg. 2018;13:33. doi: 10.1186/s13017-018-0195-0.
13. Braude D. Difficult airways are "LEMONS": updating the LEMON mneumonic to account for time and oxygen reserve. Ann Emerg Med. 2006;47(6):581. doi: 10.1016/j.annemergmed.2006.02.030.
14. Hagiwara Y, Watase H, Okamoto H, Goto T, Hasegawa K; Japanese Emergency Medicine Network Investigators. Prospective validation of the modified LEMON criteria to predict difficult intubation in the ED. Am J Emerg Med. 2015;33(10):1492-6. doi: 10.1016/j.ajem.2015.06.038.
15. Grensemann J, Simon M, Kluge S. Airway management in intensive care and emergency medicine : What is new? (In German). Med Klin Intensivmed Notfmed. 2019;114(4):334-341. doi: 10.1007/s00063-018-0498-7.
16. Mosier J, Reardon RF, DeVries PA, Stang JL, Nelsen A, Prekker ME, Driver BE. Time to Loss of Preoxygenation in Emergency Department Patients. J Emerg Med. 2020; S0736-4679(20):30667-3. doi: 10.1016/j.jemermed.2020.06.064.
17. Kalezić N, Mandraš A, Vasiljević S, Lakićević M, Sabljak V, Stevanović K. Oprema za obezbeđivanje disajnog puta i veštačkog disanja. u: Inicijalni tretman urgentnih stanja u medicini,drugo, izmenjeno i dopunjeno izdanje, urednika: Kalezić N. Medicinski fakultet, Beograd, 2016; 1(3):49-68.
18. Kalezić N, Ivošević T, Stevanović K, Cvetković A, Mitić R, Lakićević M, Pavlović A. Screening of difficult airway management - what do we often forget? 10th Sarajevo Anesthesia Forum, Book of Proceedings, Sarajevo, 2018; p-39-47.
19. Binks MJ, Holyoak RS, Melhuish TM, Vlok R, Bond E, White LD. Apneic oxygenation during intubation in the emergency department and during retrieval: A systematic review and meta-analysis. Am J Emerg Med. 2017;35(10):1542-1546. doi: 10.1016/j.ajem.2017.06.046.
20. Kalezić N, Dimić N, Karadžić Kočica M, Lakićević M. Disajni put – prioritet prvog reda hitnosti. Praxis Medica. 2019; 48(1): 31-5.
21. Kalezić N, Stojanović M, Ivošević T, Nastasović T, Lakićević M, Stojanović M. Procena disajnog puta, u: Kalezić N. Perioperativna medicina 1. 2020; 3:47-64.
22. Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, et al. Difficult Airway Society intubation guidelines working group, Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. BJA. 2015; 115(6):827-48. doi: 10.1093/bja/aev371.
23. Kalezić N, Stevanović K, Zdravković I, Sabljak V, Tošković A, Krstić S, Srećković S. Rešavanje problematičnog disajnog puta, u: Inicijalni tretman urgentnih stanja u medicini,drugo, izmenjeno i dopunjeno izdanje, urednika: Kalezić N. Medicinski fakultet, Beograd, 2016; 1(7):115-36.
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